by Peter Chen and Jim Milligan 

Using the telephone as a counselling tool has often been limited to “help lines” or telephone intake, with “real” treatment only beginning when the client enters the office of the counsellor. As the field moves to more efficient, less intrusive, more cost-effective interventions, the potential uses of the telephone, and other new technologies, are increasingly likely to become program development challenges.

Anonymity

The Issue of Anonymity is of particular importance when working with the gambling client. The shame and stigma associated with gambling may cause gamblers to be more hesitant about presenting themselves for help. Gamblers may also be hesitant to identify themselves if illegal activities are part of their gambling. Some gamblers who have been publicly entrusted with other people’s money — in financial institutions, brokerage firms, or the stock exchange — may fear exposure and subsequent loss of face. Others in positions of public trust, such as government officials, members of religious communities, doctors, social workers, lawyers, elected representatives or school teachers may fear the same repercussions. Telephone counselling might be particularly useful in these cases, especially if becoming a face-to-face client of your agency requires giving your name or other unique identifiers for the purposes of record keeping or government.

• Although telephone counselling may be more comfortable for some clients, some counsellors may find establishing rapport more difficult because they believe that they have to see the client to mirror and match him or her non-verbally.
• Some counsellors believe that their clients tend to exaggerate the truth (i.e., lie). In fact, it is commonly heard in addiction circles that clients are “liars, manipulators and cheats.” As well, many counsellors believe that they can “tell” if a person is lying, manipulating or cheating, just by looking at his or her face. For these counsellors, telephone counselling would be very challenging. So far, we have not found any references in the literature to support the belief that one person can interpret another’s state of mind consistently and accurately just by looking at him or her.
• Because non-verbal cues are missing, counsellors need to use more verbal acknowledgments than they would in a face-to-face setting where they are able to use non-verbal minimal encouragers with the clients in front of them.
• If telephone counselling is being done with a client who is unknown to the counsellor, and who lives at a distance, it is possible that the counsellor would lack the necessary knowledge of community resources. This might be critical, for example, when dealing with a suicidal client.
• Because of the dynamics involved, couple counselling can be very difficult over the phone.
• It might be important for counsellors to pay attention to their own physical discomfort when spending a long time on the telephone. Using headphones because of the discomfort factor might provide some relief.

There are some additional factors to consider when deciding whether to use telephone counselling. To reduce economic barriers for impoverished clients, it might be valuable for the program to set up a toll-free (1-800) number. Telephone clients could be encouraged to access local services instead of, or conjointly with, telephone counselling. In deciding who initiates the telephone call, personal choice or agency policy/preference should be kept in mind. Some counsellors prefer to call the client, while others will want the client to initiate the call. Finally, it might be helpful to develop some supplementary resources that could be mailed or e-mailed to telephone clients. Resources could include self-monitoring forms, relapse prevention tools, tips on journaling, reading lists, motivational articles, or names and addresses of community agencies.

Initially we were seeing clients only face-to-face. Shortly afterward, in response to calls from all over Ontario, we added a toll-free telephone counselling and information line. The calls we received came from a variety of sources, including professionals looking for advice, people who were affected by the behaviour of problem gamblers and gamblers themselves. It was not long before telephone clients accounted for up to 30% of the counsellors’ caseloads. When the Ontario Ministry of Health created a network of problem gambling treatment agencies, our long distance telephone client caseload dropped considerably. However, there still seems to be a significant need, and we continue to offer both modalities.

References

Hester, R.K. & Miller,W.R. (1995). Treatment for alcohol problems: Toward an informed eclecticism. In R.K. Hester & W.R.Miller (Eds.), Handbook of Alcoholism Treatment Approaches: Effective Alternatives (2nd ed.) (pp. 1-11). Boston: Allyn & Bacon, Inc.

Nora, R. (1989). Inpatient treatment programs for pathological gamblers. In J. Howard & S.A. Stein (Eds.), Compulsive Gambling: Theory, Research, and Practice. Lexington, MA: Lexington Books/D.C. Heath and Company.

The Oxford English Dictionary. (1989). New York: Clarendon Press.

Prochaska, J. & DiClemente, C. (1998). Toward a comprehensive, transtheoretical model of change: Stages of change and addictive behaviours. In V. Lopez (Ed.), Treating Pathological Gambling. Treating Addictive Behaviours (2nd ed.). New York: Plenum Press.

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